WASHINGTON — In this post-9/11 world even the dead don’t get a free pass through airport security.

Today anyone transporting cremated remains through an airport security checkpoint must carry the ashes in a container that allows an X-ray machine to clearly see inside, according to the beefed-up scanning guidelines outlined by the Transportation Security Administration in September.

Prior to the rule change, crematory containers still had to be scanned, but if the X-ray machines couldn’t see clearly inside the container, a simple letter or certificate of cremation from a funeral home was enough to by-pass further inspection. And before February of this year cremated remains weren’t even initially scanned, passing through security on documentation alone.

It’s not just bereaved loved ones who are finding travel in the post-9/11 world much more complicated. Similar situations are cropping up for everyone from women wearing underwire bras to those with prosthetics to recipients of recent nuclear medicine procedures.

The issue is far from trivial.

British orthopedic surgeons say more than half of the artificial implant patients they surveyed are setting off airport security alarms post-9/11. Meanwhile, with 16 million nuclear medicine procedures done every year and increasingly sensitive radiation detectors being deployed by homeland security officials, it’s no wonder these radioactive patients are being turned into unwitting targets of law enforcement, says the Nuclear Regulatory Commission.

And when it comes to transporting cremated remains by air, the TSA tightened its scanning procedures in the aftermath of the two Russian airliners that exploded almost simultaneously in August after two women smuggled bombs hidden under their clothes on-board the planes.

"We worked with the nation’s funeral homes to educate the public on the best methods to move cremated remains through checkpoints in a manner that respects the deceased and maintains a high level of security,” said Darrin Kayser, a TSA spokesman. The containers must be “security friendly.” TSA recommends they be “constructed of lightweight materials like plastic or wood that are more friendly to our security process,” Kayser said.

If the ashes can’t be properly scanned they must be transported some other way because the containers aren't permitted to be checked luggage unless they can be screened, Kayser said, noting that TSA employees aren’t allowed to open and inspect the containers.

That poses a big problem for people who want to transport their deceased loved ones. Nearly 680,000, or 30 percent of all deaths, in 2002 ended in cremation, according to the Cremation Association of North America.

Within the same time frame that TSA bolstered the procedures for inspecting cremated remains it also instituted a new physical passenger screening policy by approving the use of manual pat-down searches as well as giving screeners more latitude in whom they choose for so-called secondary screening, Kayser said.

The new pat-down searches are causing even more problems for women wearing underwire bras than before. Prior to the more rigorous physical inspection policy, the Internet was rife with first-person accounts of women who have been subjected to what they say are overly aggressive searches.

The issue is a sensitive one. “As a part of that procedure, our screeners will be doing a significant visual inspection of passengers and if they witness irregularities they will be able to use a manual pat-down search,” Kayser said. Passengers can request the inspections take place in a private area. Also, any passenger is allowed to decline the search procedures without consequence as long as they are also willing to forgo their travel plans, Kayser said.

And during a U.S. conference in April, British orthopedic surgeons presented findings of a study they did showing that patients with artificial implants, such as hip replacements, were more likely to trigger airport security checkpoint alarms, setting them off 56 percent of the time since 9/11, up from 11 percent of the time before.

The TSA has special procedures when it comes to handling prosthetic devices, Kayser said, noting that it doesn’t require anyone to remove an artificial limb.

Radioactive patients
To guard against the possibility of a terrorist’s trying to smuggle a “dirty bomb” across our borders or into a major city, the Department of Homeland Security has equipped Customs and Border Protection officers with more than 10,000 personal radiation detectors, installed more than 270 radiation portal monitors at U.S. ports of entry and set up isotope identification detection systems in places like tunnels, rail stations, shopping malls and bridges, according to Robert Bonner, who heads the Customs and Border Protection division of DHS.

But those same devices employed to sniff out a terrorist threat are also turning recipients of nuclear medicine treatments into targets of law enforcement, according to the American College of Nuclear Physicians.

“There have been reports of patients who have had nuclear medicine procedures triggering radiation monitors in public transportation facilities,” the ACNP said in a note to members last December. “Some patients who have been stopped have noted confusion among security personnel. Body searches and long delays have been reported,” the ANCP said.

The ANCP’s action came in the aftermath of a published informational notice from the Nuclear Regulatory Commission. In that notice the NRC highlighted an incident in which a bus traveling from New York to Atlantic City set off a radiation alarm in a tunnel.

The state police pulled over the bus only to find that a passenger had, earlier in the day, received a nuclear medicine procedure. The rub, the NRC noted, was that the patient was told not to take public transportation for two days on the chance that the radioactive medicine might trigger a radiation security device.

“We started seeing these problems at the end of 2001, in the aftermath of 9/11,” said John Jacobus, a health physicist for the National Institutes of Health. “A lot of the problem is that patients very often don’t realize they are radioactive,” Jacobus said. “For whatever reason it just doesn’t come up in the conversation, honest to God.”

The NRC recommends that patients be given complete explanations about how the tests could set off alarms. The ANCP and NRC also suggest that patients be given a letter containing vital information about the procedure they can carry with them that can be given to security personnel if needed.

Jacobus says that informing patients about nuclear medicine treatments is sometimes a delicate dance between providing them with adequate information yet not making them feel apprehensive.

“Patients are injected with a very small amount of material, it’s like a liquid, and the problem is that you don’t taste it or feel it or anything like that,” he said. “And then what happens, because they aren’t apprehensive, they may not be as cognitive of the fact that they are, indeed, radioactive.”

A concerted education awareness program seems to be paying off, Jacobus said. “And as a result, patients are getting smarter,” he said. “If they do set off alarms they can tell the security people all about their nuclear medicine procedure and the homeland security people now understand that.”